equipp presentation handout · 2018-04-04 · pharmacy quality measures: action steps for...

9/25/15

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Pharmacy Quality Measures: Action Steps for Improvement

Christine Jacobson Wasatch Pharmacy Care

Financial support was provided for this activity through an unrestricted grant from Health Mart Systems, Inc.

Financial Support

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Christine Jacobson is an owner of a Health Mart pharmacy. The speaker otherwise does not report any actual or potential conflicts of interest in relation to this continuing pharmacy education activity. Off-label use of medications will not be discussed during this presentation. CEI has taken appropriate action for conflict resolution, including external review by a non-conflicted peer reviewer.

Speaker Disclosure

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Pharmacist Learning Objectives

•  Explain why quality performance matters for health plans, pharmacies and patients

•  Recall five key quality measures for pharmacies, performance goals and general action steps for improvement

•  Evaluate your pharmacy’s specific performance on the five key quality measures

•  Develop a pharmacy-specific action plan to improve performance on a specific quality measure

Technician Learning Objectives

•  Explain why quality performance matters for health plans, pharmacies and patients

•  List five key quality measures for pharmacies

•  Assist the pharmacist in evaluating your pharmacy’s specific performance on the five key quality measures

Learning Objectives

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1. 2. 3.

Three things you would like to learn today:

Personal Learning Objectives

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Sanger-Katz, M. New York Times. “A Health Trade-Off That’s Here to Stay: Lower Cost, Limited Choice.” July 29, 2014. http://www.nytimes.com/2014/07/30/upshot/why-health-insurance-plans-with-narrow-networks-are-here-to-stay.html?_r=1. Accessed 08/05/2014. McKinsey & Company. McKinsey Center for U.S. Healthcare Reform. Hospital networks: Updated national view of configurations on the exchanges June 2014. http://bit.ly/1nbZdrU. Accessed 08/05/2014.

Access to Preferred Networks and Clinical Performance

Preferred networks will continue to grow

Continued trade-off of lower reimbursement rates for access to preferred networks

Clinical performance is becoming increasingly important and Star Ratings are a focus area

Clinical performance may be the best chance for independent pharmacies to compete

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Who is clinical performance important to?

• Payers and PBMs

• Pharmacies

• Patients

Why is Clinical Performance Important?

Reid RO, Partha D, Howell BL, and Shrank WH. “Association Between Medicare Advantage Plan Star Ratings and Enrollment.” JAMA. 2013;309(3):267-274. 7

Criteria for pharmacy inclusion in preferred networks

•  Coverage

•  Consumer brand

•  Cost

Historic

+•  Clinical performance

•  Operational performance

•  Certification / compliance

Future: 2015+

Cost and Clinical Quality Criteria for Access to Preferred Networks

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“Sponsor intends to limit the Preferred Network to pharmacies that can provide both the quality level of service and care reflected in the STAR activity and a competitive cost structure for medications”

Criteria Network Expectation

Network scale Broad beneficiary access to retail network

Generic dispensing rate Achieve industry standard GDR or higher

Marketing investment Participate in / contribute towards marketing the plan

Competitive rates/open to new benchmarks Willingness to experiment

Openness to clinical performance incentives

Willingness to enter into pay-for-performance reimbursement model

Positively impact Star ratings

Ability to drive high performance on star ratings

Recent RFP example

Star Ratings Measures

•  Annual rating system to grade Medicare plans •  2015 bonus payments, based on 2014 ratings, which were based on

2012–13 data

Centers for Medicare and Medicaid Services (CMS) Star Ratings

Star Rating Performance Level

Poor

Below Average

Average

Above Average

Excellent

Centers for Medicare & Medicaid Services. Prescription Drug Coverage — General Information. http://www.cms.gov/PrescriptionDrugCovGenIn/06 PerformanceData.asp. Accessed 08/06/2014. 10

Adherence: Proportion of Days Covered (PDC)

PDC: Statins

2015 Star Ratings: What is the Same?

PDC: Oral Diabetes Medications

PDC: Hypertension (Renin-angiotensin system antagonists or RASA)

Use of High-Risk Medications in the Elderly

enters for Medicare and Medicaid Services. Part C and D Performance Data. 2015 Star Ratings Measure List. http://www.cms.gov/Medicare/Prescription-Drug-Coverage/PrescriptionDrugCovGenIn/PerformanceData.html. Accessed 08/05/14.

Alternative Therapy

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Four key Part D quality measures for pharmacies to focus on remain the same:

2015 Key Star Rating Measure Goals

Measure Goal Direction 5-Star Goal %1* 2015 Top 20%2**

RASA PDC (ACE/ARB PDC) 85% 92.3%

PDC: Statins 83% 91 %

PDC: Diabetes 81% 90.4%

High-Risk Medications in the Elderly 7% 3.3%

*Based on 2015 CMS 5-Star Goals for MA-PD plans, subject to change with each plan year, and in addition, individual payers may set their own goals relative to specific initiatives

**Top 20% of retail pharmacies as reflected in EQuIPP (Data Range: October 2014-March 2015) .

Centers for Medicare and Medicaid Services. Part C and D Performance Data. Trends in Part C & D Star Rating Measure Cut Points. http://www.cms.gov/Medicare/Prescription-Drug-Coverage/PrescriptionDrugCovGenIn/PerformanceData.html. Accessed 5/30/15. Electronic Quality Improvement Platform for Plans & Pharmacies. Accessible at www.equipp.org. (Data Range: 2015). Accessed 05/30/15. 12

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Retired

Diabetes Treatment Measure

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Centers for Medicare and Medicaid Services (CMS) has made the following changes:

Star Ratings: What Is Changing?

Comprehensive Medication Review

Statin Use in Diabetes

New Full Measure

New Display Measure

2015 2016 Display 2017

Full 2018

• Expansion of quality measures to new populations – Accreditation – Commercial – Health Insurance Exchanges – Medicaid

Quality Measures: Expansion

PQA Quality Connection. PQA Adherence Measure to be included in 2015 Quality Rating System Beta Test Measure Set. August 5, 2014. Accessed 08/05/14. 14

Quality Measures: Action Steps for Improvement

•  How is PDC calculated? –  Percentage of Medicare Part D patients 18 years of age or older covered

by prescription refill records for the same medication or another in the therapeutic category during the measurement period

– Only patients with at least 2 fills of the intervention drugs are included

•  What medications are included? –  Statins – Oral Diabetic Medications –  Renin-angiotensin system (RAS) antagonists

Adherence: Proportion of Days Covered

16 Centers for Medicare & Medicaid Services. Medicare 2015 Part C & D Star Rating Technical Notes. http://www.cms.gov/Medicare/Prescription-Drug-Coverage/PrescriptionDrugCovGenIn/Downloads/2015-Star-Ratings-Technical-Notes.pdf. Accessed 08/30/14.

• Identify non-adherent patients – Targeted interventions – Run reports – Proactive drug utilization review

• Discuss with patient – Leverage behavioral coaching

Adherence: Action Steps

Health Mart. Pharmacy Quality Measures: Improving Performance Playbook. Reviewed by Pharmacy Quality Solutions. Available at: https://connect.mckesson.com/portal/site/smo/menuitem.8581e1ff1aac434915fc0f105740d0a0/?vgnextoid=1b6caf5375927410VgnVCM1000009043070aRCRD. Accessed 08/09/14. 17

Based on cause(s) for non-adherence, select the right tool or action:

Adherence: Action Steps

Cause for Non-Adherence Solution Do not know why I need to take the medication

Disease-state medication counseling using motivational interviewing approach

Forget to order refills Use electronic refill reminders

Forget to take each day Dose reminders, or if multiple meds, compliance packaging

Inconvenience of multiple medications and multiple trips to pharmacy Medication synchronizations

Intolerable side effects Therapeutic interchange/prescriber collaboration

Cost Therapeutic interchange, formulary review, patient assistance programs

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•  How is it calculated? –  Percentage of patients 65 years of age or older who received two or more

fills of a prescription for a high risk medication during measurement period •  What medications are included?

–  Specific list of high risk medications in the elderly (subset of Beers Criteria) –  Example included below, full list included as Appendix

High-Risk Medications (HRM) in the Elderly

Centers for Medicare & Medicaid Services. Medicare 2015 Part C & D Star Rating Technical Notes. http://www.cms.gov/Medicare/Prescription-Drug-Coverage/PrescriptionDrugCovGenIn/Downloads/2015-Star-Ratings-Technical-Notes.pdf. Accessed 08/30/14. The American Geriatrics Society 2012 Beers Criteria Update Expert Panel. “American Geriatrics Society Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults.” J Am Geriatr Soc 2012. Available at: http://www.americangeriatrics.org/files/documents/beers/2012BeersCriteria_JAGS.pdf. Accessed 08/07/2014. 19

• Patient identification – Prospective is key!

• Discuss with patient • Prescriber communication

High-Risk Medications (HRM) in the Elderly: Action Steps

The American Geriatrics Society 2012 Beers Criteria Update Expert Panel. “American Geriatrics Society Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults.” J Am Geriatr Soc 2012. Available at: http://www.americangeriatrics.org/files/documents/beers/2012BeersCriteria_JAGS.pdf. Accessed 08/07/2014. 20

Evidence: •  Beers Criteria Update

Key Takeaways on Impacting the Measures

Health Mart. Pharmacy Quality Measures: Improving Performance Playbook. Reviewed by Pharmacy Quality Solutions. Available at: https://connect.mckesson.com/portal/site/smo/menuitem.8581e1ff1aac434915fc0f105740d0a0/?vgnextoid=1b6caf5375927410VgnVCM1000009043070aRCRD. Accessed 08/09/14.

Diabetes treatment

Retired: Shift focus to other measures and CMR completion

Adherence

Personalizing the solution and consistent follow-up

High-risk medications

Prevention of fill or refill is key

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EQuIPP™: Evaluating Pharmacy Performance

Who has EQuIPP access to see their pharmacy specific performance?

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Getting Started: Select CMS Threshold (5-Star Goals)

EQuIPP: Store Selection of Goal Set

Taking Performance to the Next Level: Select Top 20%

Electronic Quality Improvement Platform for Plans & Pharmacies. Accessible at www.equipp.org. 24

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EQuIPP: Pharmacy Performance Report


Trend Line


Pharmacy-Specific Performance


Goal and Gap


Versus Others


Analyze Performance


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Analyze Performance


Pharmacy Performance Improvement Example

Sample Pharmacy Performance Report Action Steps

– What? •  Patient identification

– How? •  Within workflow •  Outside of workflow

– Completing targeted interventions – Pharmacy management system reporting – Vendor solutions

– Resources •  Measure-specific HRM list •  Patient target lists

Action Steps

– What? •  Discussion of potential risks with patient

– How? •  Leveraging behavioral coaching techniques •  Open ended questions

– Resources •  Coaching guides •  Behavioral coaching education

Action Steps

– What? •  Prescriber communication

– How? •  Consider leveraging a prescriber fax template •  3-day follow-up call •  Special outreach to select prescribers office

– Resources •  Review evidence-based guidelines •  Fax templates

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Sample Pharmacy Performance Improvement

Quality Performance Action Planning

•  Write in your pharmacy’s performance scores •  Consider …

–  Which measures is your pharmacy doing well in?

–  Which measures is your pharmacy below goal on? How many patients would you have to impact to get to goal on those measures?

–  Consider pharmacy specifics that may be impacting your numbers

Evaluating Your Pharmacy Performance

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•  Circle the measure(s) that your pharmacy would like to improve on

•  Select an initial action step(s)

Take Action Exercise

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Questions? CPE Access Codes: (Case sensitive)

Pharmacists Technicians

•  CE can be redeemed with The Collaborative Education Institute (CEI) at www.GoToCEI.org

•  Follow the instruction sheet and enter the unique code provided for this specific program and date

•  Redeem your CE as soon as possible but no longer than 60 days from today

CE Claim Credit Instructions

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HEALTH MART® CALL TO ACTION

Count on Reliable Distribution

Health Mart is the largest network of independent pharmacies in the nation. We’re strong, yet flexible, and we’re here to fuel your success.

THE HEALTH MART STRATEGY

We’re leveling the playing field so you can grow your business.

THE HEALTH MART DIFFERENCE

BUILT ON THE STRENGTH OF McKESSON

Optimize Your Generics

Improve Your Bottom Line

Boost Your Efficiency

Plan for Your Future

Gain Access to Preferred

Networks

Bring Patients to Your Store

Expand Your Services for

More Revenue

ROAD TO IMPROVED PHARMACY PERFORMANCE: KEY RESOURCES*

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ACTION PLANNING AND EDUCATION TOOLBOX

YOUR PHARMACY’S PERFORMANCE

ADHERENCE SOLUTIONS TOOLBOX

PROMOTIONAL TOOLBOX

CO-PILOT

• Pharmacy Quality Measures: Driving Improved Pharmacy Performance Playbook (with case studies)

• Health Mart University: CE courses on quality measures, health coaching, MTM, Med Sync, disease state-specific, and more HEALTH MART EXCLUSIVE

• EQuIPP™ Enrollment

• How to Read Your EQuIPP Dashboard Guide

• Health Mart MRA Program (AccessHealth®)

• Adherence Performance Solution (McKesson Pharmacy Systems & Automation)

• Behavioral Coaching: Pharmacy Intervention Program

• Medication Synchronization

• Medication Therapy Management

• Refill and Pill Reminders: Your Pharmacy OnlineSM

• Health Mart Marketing Hub HEALTH MART EXCLUSIVE

• Physician Outreach Program

• Health Mart Exclusive Partnership: Pharmacy Development Services (PDS) SyncRx™ and SyncRx+™ HEALTH MART EXCLUSIVE

* For additional resources and education please visit Health Mart Operations Manual & Health Mart University

HEALTH MART: TOP 20% PHARMACIES

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HEALTH MART: TOP 20% + PHARMACIES WITHIN 5%

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Health Mart Named Pharmacy Innovator of the Year by Chain Drug Review!

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ACTION STEPS

•  Monitor your pharmacy’s specific performance with EQuIPP •  Enroll if you haven’t already — included in Health Mart and AccessHealth

memberships! •  Check your Pharmacy Performance Report monthly

•  Utilize your Quality Improvement Action Plan to begin taking action in the next 30 days

•  Complete available Medication Therapy Management Case •  Mirixa: http://www.mirixa.com/for_pharmacists or 866.218.6649 •  Outcomes: http://www.outcomesmtm.com/ or 515.237.0001

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Learn, Collaborate and Network Visit www.mckessonideashare.com to learn about discounted pricing, our schedule of events, and to register for the show!

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equipp presentation handout · 2018-04-04 · pharmacy quality measures: action steps for...

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